Rate of Hemoglobin Regeneration in Blood Donors

Abstract

During the past twenty years there has been a great increase in the number of blood transfusions administered, and the recent use of normal and lyophilized serum in combating shock and in restoring the plasma proteins to their normal level promises to increase still further the already great demand for blood. In spite of the frequent use of whole blood and blood serum there have been surprisingly few studies on the rate of hemoglobin regeneration in the blood donors. Most of the recorded observations have been made on groups of professional donors who have given varying amounts of blood over a period of months or years, and the reports have been concerned with the hemoglobin and erythrocyte levels after multiple donations. Giffin and Haines 1 studied 84 donors, many of whom had given blood for 20 or more transfusions, and concluded that donations of 500 cc. of blood at intervals of four to five weeks are not harmful to male donors but that in female donors anemia often develops under similar conditions. Powell= studied 25 donors, 1 of whom had given blood for 63 transfusions, and found that anemia had devel¬ oped in only 2 of the group. Jones, Widing and Nelson 3 studied 50 donors who had given blood for a total of 175 transfusions and found that the blood hemoglobin level rapidly returned to normal. Certain donors exhibited such regenerative ability that the withdrawal of 1,200 to 2,000 cc. of blood within a period of one to twenty-three days was followed by a return of the hemoglobin level to normal within ten days. Martin and Myers4 found an average reduction of 310.000 in the erythrocyte count and a 5.2 per cent drop in the hemoglobin level following the removal of 500 cc. of blood. The minimum values were found six hours after the bleeding. No ill effects were noted in 10 donors who had given blood for a total of 52 transfusions, but Martin and Myers expressed the belief that blood should not be taken more frequently than every three months. They too noted that hemoglobin regeneration is slower in female than in male donors. The same interval, three months, between blood donations was recommended by Brewer 5 after observations on 1,076 donors, although he found that the hemoglobin had returned to its normal level at the end of two months in most donors. Cadham°found that six months after the withdrawal of small amounts of blood for trans¬ fusions of convalescent serum there was no anemia and most of the subjects felt better than they had prior to the blood donations.Less encouraging reports have been given by other investigators,7 who have found instances of persistent anemia after repeated donations of blood, and in some cases8 a reduction in the leukocyte count has been noted. A study of 101 Chinese donors9 revealed a reduction in the blood hemoglobin that paralleled the amount of blood withdrawn and the time that the subject had been serving as a blood donor. The anemia was of the microcytic type, and glossitis, achlorhydria and splenomegaly were occasionally encountered. The slower hemopoietic response i...

The donation interval of 56 days requires extension to 180 days for whole blood donors to recover from changes in iron metabolism

“…1 In accordance with guidelines of regulatory agencies and to protect whole blood donors from developing ID and anemia, many blood establishments worldwide require a minimum interval of 56 days between 2 donations. 2,3 This interval is based on studies from the 1940s and 1950s, investigating recovery of (only) Hb, 4,5 but more recently, it was reported to be too short to prevent ID. 6,7 Because Hb falls short as a marker for nonanemic ID, 8,9 and to prevent blood donors from developing ID, there is a need for additional insights into the kinetics of red cell indices and iron parameters over time after blood donation.…”

“…4,5 Recently, in the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) study involving fewer time points and iron parameters, investigators also observed a decrease of Hb and hepcidin and increase of reticulocyte count and EPO upon blood donation. 16 Moreover, and similar to our observations, they found that (1) absolute hepcidin levels decreased more in high ferritin donors, whereas EPO increased more in those with low ferritin, indicating that erythropoietic response to severe blood loss varies with baseline iron stores, and (2) recovery to baseline ferritin levels in high ferritin donors was less complete.…”

Control of marrow production by the level of iron supply

“…Whereas the iron delivered from normal reticuloendothelial stores or orally administered iron is sufficient for a marrow production response of only two to three times normal, the increased iron supply from nonviable red cells, hemolysis, or iron dextran infusions permits marrow production to rise acutely to levels of four to eight times normal. INTRODUCTION Although erythropoiesis has been extensively studied in a wide spectrum of disease states (1)(2)(3)(4)(5)(6)(7), there have been very few studies of the characteristics of the normal marrow response to varying degrees of anemia (8)(9)(10)(11)(12)(13)(14)(15). The wide variation in the level of red cell production which occurs with different anemias has been considered to be a function of both the relative level of hematocrit depression and a variety of biochemical abnormalities and cofactor deficiencies which interfere with cell growth and maturation.…”

The Estimation and Control of Post-Operative Dehydration, With the Aid of Hemoglobin and Plasma Protein Determinations 1

“…The rate at which the hemoglobin concentration falls after bleeding is shown in Figure 1 ( 11), and by others who have worked on the same subject ). The purpose of the figure is to show that the post-operative fall in hemoglobin follows a smooth curve, and that it is virtually complete by the third post-operative day.…”